Why healthcare needs to rethink how it defines and values EMS

As Congress considers legislation that would allow Medicare to reimburse certain EMS services when a patient is treated in place rather than transported, it raises a larger question: Is healthcare still defining EMS by the ride instead of the clinical care?

After a career spent building and operating EMS organizations, I believe we need to look at emergency medical services differently.

AmeriPro Health is not simply a transportation company that practices medicine. It is a distributed clinical enterprise whose exam room happens to move.

That distinction matters. It changes how hospitals think about patient flow, how payers think about healthcare costs, how communities think about access to care and how policymakers think about a payment system that has historically tied reimbursement to transportation rather than clinical judgment.

The Scale of Mobile Medicine

Every day, AmeriPro Health clinicians respond to between 650 and 700 patients across roughly 10 states in the Southeast and Midwest. Some have called 911 on the worst day of their lives and depend on 911 emergency medical services to reach them fast. Others are being moved between hospitals, skilled nursing facilities and other care settings while requiring oxygen, monitoring or other medical support.

That adds up to more than 240,000 patient encounters each year.

Yet healthcare has a habit of counting what happens inside hospitals and overlooking what happens outside their walls. An emergency department is recognized as essential clinical infrastructure. An ambulance is often viewed primarily as the vehicle that gets someone there.

But in many communities, particularly rural ones, the ambulance is more than a bridge to the healthcare system. It may be the most reliable clinical resource that can reach a patient where they are.

EMS as the First Touchpoint With the Healthcare System

EMS clinicians are uniquely positioned to see patients in their homes and communities, often at a moment when other healthcare providers cannot.

They may see medications that have not been filled, fall hazards in the home, difficulty managing a treatment plan or other circumstances that can affect a person's health long before those issues result in a hospital visit.

Those observations provide insight into the realities that influence whether a patient can safely manage care at home and whether additional intervention may be needed. As healthcare places greater emphasis on prevention, care coordination and keeping patients in the most appropriate setting, that information can become an increasingly valuable part of the larger care picture.

Every Encounter Is a Clinical Decision

The most important part of an ambulance encounter is not necessarily the transport. It is the clinical assessment and the decision about what should happen next.

A qualified EMS clinician, whether providing basic life support or advanced life support, may determine that a patient needs an emergency department. In other cases, the appropriate course may be treatment on scene, referral to another level of care or follow-up with an existing provider.

In other words, transport is only one possible outcome of a clinical encounter.

Yet the traditional payment model has largely been built around transportation. That creates a disconnect between what EMS clinicians actually do and what the healthcare system reimburses.

This issue is at the center of legislation now before Congress, including H.R. 7277 and S. 3730, which would address Medicare reimbursement for certain ambulance services when a patient is treated but not transported. Often called treatment in place, this approach recognizes that the clinical encounter has value on its own.

The legislation reflects a broader question facing healthcare: Should payment follow the clinical decision, or only the vehicle?

Treatment in Place: When the Best Outcome Is Not a Hospital

For patients who do not require emergency department care, avoiding an unnecessary trip to the hospital can benefit everyone.

The patient may avoid an expensive and disruptive emergency department visit. Hospitals can preserve capacity for patients who need it. Payers may avoid unnecessary costs. And EMS clinicians can help connect patients with a more appropriate next step.

During the COVID-19 pandemic, Medicare temporarily expanded reimbursement for certain treatment-in-place services, providing experience with an approach that allows some patients to receive care where they are.

The lesson is not that every patient should avoid the hospital. It is that the right destination should be determined by clinical judgment, not by a payment structure that assumes transportation is always the goal.

Inter-Facility Transport Is Part of the Care Transition

The same principle applies when an ambulance transports a patient.

What is sometimes described simply as "non-emergency transportation" can involve patients who are medically fragile, dependent on oxygen or monitoring, or otherwise unable to safely travel by conventional transportation.

Moving these patients between hospitals, skilled nursing facilities and other care settings through inter-facility transport is not simply a logistical step. It is part of the patient's care transition, and for the most medically complex patients, it may require critical care transport.

A safe, reliable transition can help a hospital complete a discharge, free up a bed and give the next care setting the opportunity to continue treatment without unnecessary disruption. When that transition breaks down, the effects can extend throughout the healthcare system.

For hospitals, EMS can therefore be part of the infrastructure that supports patient flow. For patients and families, it can provide continuity of care during a vulnerable point in the healthcare journey.

EMS Reimbursement: A Payment Model Catching Up With Clinical Reality

The healthcare system is beginning to recognize what EMS operators have long understood: the value of an EMS encounter does not begin when the ambulance starts moving.

As states expand the ability of EMS clinicians to treat certain patients in place, federal EMS reimbursement policy is beginning to address the same issue.

The principle should be straightforward: payment and accountability should align with the clinical decision, wherever that decision is made.

That means recognizing clinical judgment when a patient is treated on scene rather than transported, as well as the clinical role EMS plays when a medically complex patient is safely transitioned between care settings.

A healthcare system that increasingly values outcomes, appropriate utilization and care in the right setting should also recognize the clinicians already making those decisions in homes, communities and on the road.

Rethinking the Role of EMS

For decades, it has been easy to think of EMS primarily as the service that gets patients from one place to another.

That description no longer captures the full role EMS plays in healthcare.

EMS clinicians assess patients, provide treatment, make decisions, support care transitions and see patients in environments that other parts of the healthcare system may never reach. That is the work behind every AmeriPro Health service, from the emergency scene to the next care setting.

The question now is whether healthcare policy and payment will catch up with that reality.

The future of EMS should not be measured simply by how many miles an ambulance travels or how many patients it transports. It should be measured by the clinical decisions made, the care delivered and whether patients reach the right level of care at the right time.

The transport might be how the patient encounter ends, but not how we define the encounter.

Thomas McEntee is Chief Business Officer at AmeriPro Health. To learn how AmeriPro works with health systems, counties and municipalities to deliver high-performance EMS, visit our Partner With Us page.